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Liver dysfunction by model for end-stage liver disease score improves mortality prediction in injured patients with cirrhosis.
J Trauma. 2011 Jul; 71(1):6-11.JT

Abstract

BACKGROUND

Cirrhosis is associated with poor outcomes in the trauma setting. We aimed to evaluate the utility of Model for End-Stage Liver Disease (MELD) in assessing additional mortality risk in trauma patients with cirrhosis.

METHODS

Injured patients with liver dysfunction were identified by hospital and trauma registry query. Presence of cirrhosis was confirmed by laparotomy, biopsy, or imaging. MELD classification, Child-Turcotte-Pugh (CTP) classification, Injury Severity Score (ISS), and Trauma ISS (TRISS) were recorded, and the primary outcome variable was hospital mortality. We assessed the validity of the four scoring systems in prediction of mortality, individually and in combinations, by comparing the areas under receiver operating characteristic curves (AUC), which is the probability, for scores that increase with the risk of death that a randomly chosen deceased subject will score higher than a randomly chosen living subject.

RESULTS

A total of 163 patients with confirmed cirrhosis were included. ISS (AUC = 0.849, p < 0.001) and TRISS (AUC = 0.826, p < 0.001) were the strongest predictors of mortality. MELD (AUC = 0.725) was not a significantly stronger predictor of mortality than CTP (AUC = 0.639; p = 0.38). ISS + MELD (AUC = 0.891) and ISS + CTP (AUC = 0.897) were stronger predictors than ISS alone (AUC = 0.849; p < 0.001) for both. The MELD score was more available from the records than the CTP score (91.4% vs. 75.5%).

CONCLUSION

In trauma patients with cirrhosis, a score that evaluates the degree of liver dysfunction enhances the ability of ISS alone to predict mortality. The MELD score is more readily available than the CTP score for the prediction of mortality in trauma patients.

Authors+Show Affiliations

Department of Surgery and Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio, TX, USA. corneille@uthscsa.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

21818010

Citation

Corneille, Michael G., et al. "Liver Dysfunction By Model for End-stage Liver Disease Score Improves Mortality Prediction in Injured Patients With Cirrhosis." The Journal of Trauma, vol. 71, no. 1, 2011, pp. 6-11.
Corneille MG, Nicholson S, Richa J, et al. Liver dysfunction by model for end-stage liver disease score improves mortality prediction in injured patients with cirrhosis. J Trauma. 2011;71(1):6-11.
Corneille, M. G., Nicholson, S., Richa, J., Son, C., Michalek, J., Wolf, S. E., & Stewart, R. (2011). Liver dysfunction by model for end-stage liver disease score improves mortality prediction in injured patients with cirrhosis. The Journal of Trauma, 71(1), 6-11. https://doi.org/10.1097/TA.0b013e31822311c5
Corneille MG, et al. Liver Dysfunction By Model for End-stage Liver Disease Score Improves Mortality Prediction in Injured Patients With Cirrhosis. J Trauma. 2011;71(1):6-11. PubMed PMID: 21818010.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Liver dysfunction by model for end-stage liver disease score improves mortality prediction in injured patients with cirrhosis. AU - Corneille,Michael G, AU - Nicholson,Susannah, AU - Richa,Jacqueline, AU - Son,Colin, AU - Michalek,Joel, AU - Wolf,Steven E, AU - Stewart,Ronald, PY - 2011/8/6/entrez PY - 2011/8/6/pubmed PY - 2011/10/20/medline SP - 6 EP - 11 JF - The Journal of trauma JO - J Trauma VL - 71 IS - 1 N2 - BACKGROUND: Cirrhosis is associated with poor outcomes in the trauma setting. We aimed to evaluate the utility of Model for End-Stage Liver Disease (MELD) in assessing additional mortality risk in trauma patients with cirrhosis. METHODS: Injured patients with liver dysfunction were identified by hospital and trauma registry query. Presence of cirrhosis was confirmed by laparotomy, biopsy, or imaging. MELD classification, Child-Turcotte-Pugh (CTP) classification, Injury Severity Score (ISS), and Trauma ISS (TRISS) were recorded, and the primary outcome variable was hospital mortality. We assessed the validity of the four scoring systems in prediction of mortality, individually and in combinations, by comparing the areas under receiver operating characteristic curves (AUC), which is the probability, for scores that increase with the risk of death that a randomly chosen deceased subject will score higher than a randomly chosen living subject. RESULTS: A total of 163 patients with confirmed cirrhosis were included. ISS (AUC = 0.849, p < 0.001) and TRISS (AUC = 0.826, p < 0.001) were the strongest predictors of mortality. MELD (AUC = 0.725) was not a significantly stronger predictor of mortality than CTP (AUC = 0.639; p = 0.38). ISS + MELD (AUC = 0.891) and ISS + CTP (AUC = 0.897) were stronger predictors than ISS alone (AUC = 0.849; p < 0.001) for both. The MELD score was more available from the records than the CTP score (91.4% vs. 75.5%). CONCLUSION: In trauma patients with cirrhosis, a score that evaluates the degree of liver dysfunction enhances the ability of ISS alone to predict mortality. The MELD score is more readily available than the CTP score for the prediction of mortality in trauma patients. SN - 1529-8809 UR - https://www.unboundmedicine.com/medline/citation/21818010/Liver_dysfunction_by_model_for_end_stage_liver_disease_score_improves_mortality_prediction_in_injured_patients_with_cirrhosis_ DB - PRIME DP - Unbound Medicine ER -